Referral writing: Consensus building on a tool for writing structured referrals.

Competency in referral writing skill is needed by doctors for which they are not adequately trained. Although there has been a lot of discussion on improvement of skills for writing consultation letters, still priority is not given to this important task. Ideally there should be a course with assessment for teaching and learning medical referral writing skills for students. Currently, there is no such tool to assess the way communication letters are written. An 18-point assessment scale has been developed through Delphi technique to improve the quality of referral letters. The objective of the present study was to design a structured Proforma for writing referrals, with the consensus of seven participants using Delphi. The place of study was Rawalpindi medical university and allied hospitals. Results were finalised after the acceptance of structured referral by selected participants through Delphi. The response rate was 70%. The validity and interrater reliability were calculated using SPSS25. The Cronbach's alpha was 0.7 and Kappa was 0.3. Both were statistically significant. The designed Proforma for writing referrals, with its interrater reliability calculated, seems effective for writing effective and structured referrals. The study further recommends training junior doctors in making effective referrals.

Thoughtful surgical practice for therapeutic self: A randomized control trial.

OBJECTIVES: To determine the role of structured reflection in teaching basic surgical skills in undergraduate students. METHODS: A randomized control trial was done in two medical colleges of Punjab, from January to December 2017 in which participants were divided into two groups through stratified random sampling. Structured reflection was done by interventional group after training. Post-test was taken to assess their surgical skills. Independent t-test compared the mean of two groups. One-way ANOVA was calculated to measure the difference within the different sub-categories of experimental group. RESULTS: Out of 140 students that participated in the study, 138 students stayed till the end (retention rate 98.5%, attrition rate 1.5%). Independent t-test (p-value = 0.01) showed statistically significant difference in both control and interventional groups. One-way ANOVA with robust test of equality of Means showed a positive relationship of reflective capacity and acquisition of surgical skills. CONCLUSION: The novices who demonstrates better reflective capacity exhibit better acquisition of surgical skills.

Frequency of Extensively Drug-Resistant Gram-Negative Pathogens in a Tertiary Care Hospital in Pakistan.

Background Gram-negative bacteria are frequently involved in nosocomial infections. These bacteria have a particular tendency to develop antibiotic resistance and may become extensively drug-resistant (XDR). This study aimed to detect the prevalence of XDR Gram-negative bacteria in a tertiary care hospital in Pakistan. Materials and methods Clinical samples were obtained from patients admitted to different inpatient wards and sent for microbial analysis and culture. Antibiotic susceptibility testing of isolates was performed by the disk diffusion method to detect XDR strains. Results Antibiotic susceptibility patterns of a total of 673 clinical samples were studied. Of all bacterial isolates, 64% were extensively drug-resistant. Klebsiella pneumoniae had the highest percentage of XDR isolates (68.4%), followed by Pseudomonas aeruginosa (67.6%) and Escherichia coli (56.1%). Most XDR pathogens were isolated from the burn unit (87.7%), followed by the intensive care unit (69.2%) and surgical unit (68.9%). Conclusions The rate of extensive drug-resistance is alarmingly high, which calls for strict surveillance and control measures to prevent the development of further resistance. Proper sanitation and rational prescription of antibiotics should be ensured.